Please fill out all of the forms. The last form is to screening for our Sliding Fee Scale. That form is optional, but we encourage you to find out if you’re eligible to take advantage of this cost-saving program by visiting our Sliding Fee Scale info page or calling the clinic at 765-377-1205.
As you work your way through the forms below, you’ll be asked to acknowledge our Attendance Policy. You can review and download this policy and info about our clinics by downloading our Policy Packet.